Provider Demographics
NPI:1043279755
Name:RIDDLE, CHARLOTTE (MD)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:
Last Name:RIDDLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1869
Mailing Address - Street 2:
Mailing Address - City:FLETCHER
Mailing Address - State:NC
Mailing Address - Zip Code:28732-1869
Mailing Address - Country:US
Mailing Address - Phone:828-687-5616
Mailing Address - Fax:828-650-8076
Practice Address - Street 1:50 HOSPITAL DRIVE
Practice Address - Street 2:SUITE 5D
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28792-5247
Practice Address - Country:US
Practice Address - Phone:828-650-8032
Practice Address - Fax:828-650-8033
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9801037208000000X, 2080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8985116Medicaid
NC1160UOtherBCBS OF NC
SCN01037OtherSC MEDICAID
NCG84522Medicare UPIN
NC8985116Medicaid